Regimen-Related Oral Mucosal Injury: Pathobiology, Clinical Consequences and Rationale for Intervention Across Cancer Treatment Modalities

PURPOSE OF REVIEW: Mucosal injury of the alimentary tract (mucositis) has been a consistent, markedly symptomatic, and clinically disruptive side effect of conventional cytotoxic chemotherapy and radiotherapy regimens since their inception. Despite its impact, mucositis remains a significant unmet clinical need as available treatment options are sparse. This review uses oral mucositis as a predicate regimen-related toxicity to provide a comparative discussion of the pathobiology, clinical features, and risk factors of regimen-related mucosal injury by therapy class.

RECENT FINDINGS: The alimentary tract, especially the mouth, has not escaped collateral damage from newer forms of cancer therapy including targeted agents, immunotherapy, and antibody-drug conjugates. A critical assessment of the field reveals persistent challenges that have hindered the development of effective, mechanistically-based treatments across both conventional and emerging therapy classes. Recognizing the consistent observation that regimen-related toxicities routinely occur in clusters, common pathobiological underpinnings are noted in support of unified, systemic mitigation strategies.